碳酸氢盐林格氏液水化对食管癌患者顺铂所致急性肾损伤的影响：一项回顾性队列研究

Effect of Hydration with Bicarbonate Ringer's Solution on Cisplatin-Induced Acute Kidney Injury in Patients with Esophageal Cancer: A Retrospective Cohort Study.

作者信息

Takemura Miho, Ikemura Kenji, Okuda Masahiro

机构信息

Department of Clinical Pharmacy Research and Education, Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Japan.

Department of Pharmacy, Osaka University Hospital, Suita, Japan.

出版信息

Oncology. 2025;103(1):22-29. doi: 10.1159/000540637. Epub 2024 Jul 29.

DOI:10.1159/000540637

PMID:39074453

Abstract

INTRODUCTION

Cisplatin (CDDP) often causes acute kidney injury (AKI), and magnesium supplementation has been suggested to be important in preventing CDDP-induced AKI. Sodium bicarbonate Ringer's solution (BRS) is a crystalloid solution composed of various electrolytes, including Mg2+, and can be generally used to supplement missing extracellular fluid and correct metabolic acidosis; however, the clinical outcomes of hydration with BRS for CDDP-induced AKI remain unclear. In this study, we retrospectively compared the effects of BRS and normal saline for hydration in patients undergoing CDDP treatment.

METHODS

We analyzed the incidence rate of AKI (grade ≥ 1), the severity of AKI, the serum magnesium level, and the incidence rate of grade ≥ 3 hematological toxicities (leukopenia, neutropenia, anemia, or thrombocytopenia) following CDDP and fluorouracil (5-FU) administration in 131 in-patients who received CDDP and 5-FU for the first time to treat esophageal cancer.

RESULTS

Fifty-six patients (43%) received saline alone, while 75 patients (57%) received BRS for hydration. The incidence rate of AKI (grade ≥ 1) was significantly lower in the BRS group (11%) than that in the saline group (39%, p < 0.001). Moreover, severe AKI (grade ≥ 2) was significantly less common in the BRS group than in the saline group. Although the serum magnesium levels before CDDP administration were not significantly different between the two groups (p = 0.939), the serum magnesium levels on days 2-3 after CDDP administration in the BRS group were significantly higher than those in the saline group (p < 0.001). In contrast, there were no significant differences in the incidence rates of hematological toxicity between the two groups. Multivariate analysis revealed that BRS use was an independent factor that significantly contributed to AKI prevention (odds ratio = 0.061, p < 0.001).

CONCLUSION

Hydration with BRS could prevent CDDP-induced AKI in patients with esophageal cancer.

摘要

引言

顺铂（CDDP）常导致急性肾损伤（AKI），补充镁被认为对预防顺铂诱导的急性肾损伤很重要。碳酸氢钠林格液（BRS）是一种由包括Mg2+在内的多种电解质组成的晶体溶液，通常用于补充缺失的细胞外液和纠正代谢性酸中毒；然而，BRS补液治疗顺铂诱导的急性肾损伤的临床效果仍不清楚。在本研究中，我们回顾性比较了BRS和生理盐水对接受顺铂治疗患者的补液效果。

方法

我们分析了131例首次接受顺铂和氟尿嘧啶（5-FU）治疗食管癌的住院患者在接受顺铂和5-FU治疗后急性肾损伤（≥1级）的发生率、急性肾损伤的严重程度、血清镁水平以及≥3级血液学毒性（白细胞减少、中性粒细胞减少、贫血或血小板减少）的发生率。

结果

56例患者（43%）仅接受生理盐水补液，而75例患者（57%）接受BRS补液。BRS组急性肾损伤（≥1级）的发生率（11%）显著低于生理盐水组（39%，p<0.001）。此外，BRS组严重急性肾损伤（≥2级）的发生率明显低于生理盐水组。虽然两组在顺铂给药前的血清镁水平无显著差异（p=0.939），但BRS组在顺铂给药后第2-3天的血清镁水平显著高于生理盐水组（p<0.001）。相比之下，两组血液学毒性的发生率无显著差异。多因素分析显示，使用BRS是预防急性肾损伤的一个独立因素（优势比=0.061，p<0.001）。